How much does Medicare pay for CPT 67903?

Medicare allowed an average of $672.04 per service and paid $531.61 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3322.17, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 67903?

Shortening or advancement of upper eyelid muscle to correct drooping or paralysis. It was billed 6,883 times to 5,407 Medicare beneficiaries by 233 providers in 2024.

Does 67903 pay differently in an office than a hospital?

Yes. The allowed amount averaged $665.15 in an office setting and $672.61 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 67903 most?

Ambulatory Surgical Center, with 3,479 services from 91 clinicians. Next are Ophthalmology, Plastic and Reconstructive Surgery.

CPT 67903

Shortening or advancement of upper eyelid muscle to correct drooping or paralysis

$672.04Medicare-allowed amount per service, averaged across 6,883 services

Providers submitted

$3322.17

Asking price, not received

Medicare allowed

$672.04

The fee schedule figure

Medicare paid

$531.61

Balance is patient coinsurance

Providers submitted an average of $3322.17 for this code and Medicare allowed $672.04 — 4.9× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $531.61 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $665.15
Hospital / facility: $672.61

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 526 services were billed in an office setting and 6,357 in a facility.

Services: 6,883
Beneficiaries: 5,407
Providers billing it: 233
Total allowed: $4,625,651

What Medicare pays for CPT 67903

Across 6,883 services billed by 233 providers to 5,407 beneficiaries, Medicare allowed an average of $672.04 per service. That is 1.3 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 67903

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	3,479	2,074	$743.42	91
Ophthalmology	3,365	3,294	$598.31	140
Plastic and Reconstructive Surgery	39	39	$666.15	2

67903 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	1,230	$755.88	$526.89	40
Texas	1,095	$639.19	$517.41	34
Florida	555	$659.67	$525.22	16
Colorado	509	$651.03	$520.17	10
Illinois	256	$673.10	$513.22	7
Washington	254	$716.69	$536.55	9
Kansas	227	$602.17	$513.52	6
South Carolina	185	$564.56	$477.76	6
New York	178	$663.73	$526.54	6
New Jersey	166	$774.94	$564.25	5
New Hampshire	159	$674.69	$545.44	4
Maryland	150	$652.91	$503.27	7
Missouri	144	$669.36	$585.76	5
Tennessee	130	$651.63	$561.91	6
Massachusetts	129	$711.38	$535.39	5
Arizona	125	$659.89	$538.26	5
Alabama	122	$637.51	$573.20	5
Idaho	119	$558.80	$486.46	4
Ohio	112	$696.71	$569.92	6
Vermont	97	$693.32	$554.25	2
South Dakota	92	$675.81	$590.76	1
North Carolina	92	$587.35	$480.74	5
Oklahoma	84	$606.71	$520.39	3
Iowa	77	$665.20	$563.55	2
Pennsylvania	71	$619.42	$499.81	4
Georgia	66	$699.22	$544.98	4
Kentucky	56	$572.86	$470.09	2
Nebraska	45	$625.28	$530.77	2
Virginia	42	$646.11	$496.52	3
Utah	41	$698.80	$580.09	2
Minnesota	40	$710.73	$548.90	2
Alaska	35	$805.42	$555.00	2
Nevada	32	$512.55	$396.65	2
Michigan	32	$569.01	$488.24	2
Hawaii	28	$807.81	$617.03	1
Oregon	26	$719.59	$518.78	2
Louisiana	26	$577.09	$456.80	2
Maine	23	$690.99	$544.59	2
Rhode Island	22	$535.68	$431.41	1
Wisconsin	11	$576.44	$444.85	1

Related codes

67904Repair of tendon of upper eyelid$756.97
67917Extensive repair of turning-outward eyelid defect$572.32
67900Repair of brow paralysis$549.88
67908Removal of tissue$669.86
67950Reconstruction of eyelid margin$489.92
67924Extensive repair of turning-inward eyelid defect$625.44
67966Removal of over 1/4 of eyelid margin and repair of eyelid$684.96
67938Removal of embedded foreign body in eyelid$316.68
67961Removal of up to 1/4 of eyelid margin and repair of eyelid$560.01
67911Correction of widely-opened upper eyelid$512.98

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.